NUR 242 – MEDICAL-SURGICAL NURSING CONCEPTS – GALEN COLLEGE OF NURSING
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
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Core Domains:
Perioperative Nursing
Fluid & Electrolyte Balance
Acid-Base Disorders
Pain Management
Wound Healing & Pressure Injuries
Endocrine Disorders (Diabetes, Thyroid)
Cardiovascular Disorders (HF, MI, HTN)
Respiratory Disorders (COPD, Pneumonia)
Renal & Urinary Disorders
Legal & Ethical Nursing Practice
Introduction
*This comprehensive examination is designed to assess mastery of essential medical-surgical nursing concepts
for NUR 242 at Galen College of Nursing. It measures foundational theory, clinical reasoning, regulatory
compliance, ethical decision-making, and real-world scenario application. The exam consists of 200 multiple-
choice questions divided into two sections, each requiring critical thinking and prioritization skills. Questions
reflect NCLEX-style formats and emphasize safe, patient-centered care across diverse healthcare settings.
,Correct answers are verified with concise rationales to reinforce learning and clinical judgment. This assessment
supports exam readiness and professional nursing practice.*
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a patient with heart failure who reports shortness of breath and has +4 peripheral
edema. Which action should the nurse take first?
A. Administer furosemide as ordered
B. Place the patient in high Fowler’s position
C. Check serum potassium level
D. Restrict oral fluids to 1,000 mL/day
🟢B
🔴 RATIONALE: High Fowler’s position reduces preload and improves lung expansion, addressing respiratory
distress immediately before pharmacological or laboratory interventions.
2. A postoperative patient’s serum sodium level is 128 mEq/L. Which assessment finding is most concerning?
A. Dry mucous membranes
B. Muscle twitching
C. Altered mental status
D. Thready pulse
🟢C
🔴 RATIONALE: Acute hyponatremia (≤130 mEq/L) can cause cerebral edema and seizures. Altered mental
status indicates severe neurological compromise requiring urgent intervention.
,3. A nurse is teaching a patient with type 1 diabetes about sick-day rules. Which statement indicates correct
understanding?
A. “I will stop my insulin if I cannot eat.”
B. “I will check my blood glucose every 4 hours.”
C. “I will drink sugar-free liquids only.”
D. “I will call my provider if my glucose is over 200 mg/dL.”
🟢B
🔴 RATIONALE: During illness, blood glucose should be monitored q4h to detect hyperglycemia from stress
hormones. Insulin should never be stopped, and glucose >250 mg/dL with illness warrants provider notification.
4. A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas (ABG) result: pH 7.32,
PaCO2 68 mm Hg, HCO3 32 mEq/L. Which interpretation is correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Mixed metabolic acidosis
🟢B
🔴 RATIONALE: Low pH and elevated PaCO2 indicate respiratory acidosis; elevated HCO3 shows renal
compensation but pH remains abnormal, so it is partially compensated.
5. A nurse is assessing a pressure injury on the sacrum that presents with full-thickness tissue loss, visible fat,
and slough. What stage is this?
A. Stage 2
B. Stage 3
, C. Unstageable
D. Deep tissue injury
🟢B
🔴 RATIONALE: Stage 3 pressure injury involves full-thickness loss with visible fat but not fascia, muscle, or
bone. Slough may be present but does not obscure depth.
6. Which finding in a patient receiving morphine via patient-controlled analgesia (PCA) requires immediate
action?
A. Respiratory rate of 10 breaths/min
B. Nausea after a meal
C. Pain rated 4/10
D. Drowsiness when undisturbed
🟢A
🔴 RATIONALE: Respiratory rate <12 breaths/min indicates opioid-induced respiratory depression, a life-
threatening adverse effect requiring naloxone and discontinuation.
7. A patient with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which intervention should the
nurse anticipate first?
A. Oral sodium polystyrene sulfonate
B. IV calcium gluconate
C. IV furosemide
D. Restrict dietary potassium
🟢B
🔴 RATIONALE: IV calcium gluconate stabilizes cardiac membranes in severe hyperkalemia, preventing
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
Core Domains:
Perioperative Nursing
Fluid & Electrolyte Balance
Acid-Base Disorders
Pain Management
Wound Healing & Pressure Injuries
Endocrine Disorders (Diabetes, Thyroid)
Cardiovascular Disorders (HF, MI, HTN)
Respiratory Disorders (COPD, Pneumonia)
Renal & Urinary Disorders
Legal & Ethical Nursing Practice
Introduction
*This comprehensive examination is designed to assess mastery of essential medical-surgical nursing concepts
for NUR 242 at Galen College of Nursing. It measures foundational theory, clinical reasoning, regulatory
compliance, ethical decision-making, and real-world scenario application. The exam consists of 200 multiple-
choice questions divided into two sections, each requiring critical thinking and prioritization skills. Questions
reflect NCLEX-style formats and emphasize safe, patient-centered care across diverse healthcare settings.
,Correct answers are verified with concise rationales to reinforce learning and clinical judgment. This assessment
supports exam readiness and professional nursing practice.*
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a patient with heart failure who reports shortness of breath and has +4 peripheral
edema. Which action should the nurse take first?
A. Administer furosemide as ordered
B. Place the patient in high Fowler’s position
C. Check serum potassium level
D. Restrict oral fluids to 1,000 mL/day
🟢B
🔴 RATIONALE: High Fowler’s position reduces preload and improves lung expansion, addressing respiratory
distress immediately before pharmacological or laboratory interventions.
2. A postoperative patient’s serum sodium level is 128 mEq/L. Which assessment finding is most concerning?
A. Dry mucous membranes
B. Muscle twitching
C. Altered mental status
D. Thready pulse
🟢C
🔴 RATIONALE: Acute hyponatremia (≤130 mEq/L) can cause cerebral edema and seizures. Altered mental
status indicates severe neurological compromise requiring urgent intervention.
,3. A nurse is teaching a patient with type 1 diabetes about sick-day rules. Which statement indicates correct
understanding?
A. “I will stop my insulin if I cannot eat.”
B. “I will check my blood glucose every 4 hours.”
C. “I will drink sugar-free liquids only.”
D. “I will call my provider if my glucose is over 200 mg/dL.”
🟢B
🔴 RATIONALE: During illness, blood glucose should be monitored q4h to detect hyperglycemia from stress
hormones. Insulin should never be stopped, and glucose >250 mg/dL with illness warrants provider notification.
4. A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas (ABG) result: pH 7.32,
PaCO2 68 mm Hg, HCO3 32 mEq/L. Which interpretation is correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Mixed metabolic acidosis
🟢B
🔴 RATIONALE: Low pH and elevated PaCO2 indicate respiratory acidosis; elevated HCO3 shows renal
compensation but pH remains abnormal, so it is partially compensated.
5. A nurse is assessing a pressure injury on the sacrum that presents with full-thickness tissue loss, visible fat,
and slough. What stage is this?
A. Stage 2
B. Stage 3
, C. Unstageable
D. Deep tissue injury
🟢B
🔴 RATIONALE: Stage 3 pressure injury involves full-thickness loss with visible fat but not fascia, muscle, or
bone. Slough may be present but does not obscure depth.
6. Which finding in a patient receiving morphine via patient-controlled analgesia (PCA) requires immediate
action?
A. Respiratory rate of 10 breaths/min
B. Nausea after a meal
C. Pain rated 4/10
D. Drowsiness when undisturbed
🟢A
🔴 RATIONALE: Respiratory rate <12 breaths/min indicates opioid-induced respiratory depression, a life-
threatening adverse effect requiring naloxone and discontinuation.
7. A patient with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which intervention should the
nurse anticipate first?
A. Oral sodium polystyrene sulfonate
B. IV calcium gluconate
C. IV furosemide
D. Restrict dietary potassium
🟢B
🔴 RATIONALE: IV calcium gluconate stabilizes cardiac membranes in severe hyperkalemia, preventing
